Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4612_Библиотеки_им_академика_М_И_Перельмана
.pdf
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
232
Durmaz, A., Karahatay, S., Satar, B., Birkent, H., &
Hidir, Y. (2009). Efficiency of Stenger test in confirming profound, unilateral pseudohypacusis. The
Journal of Laryngology & Otology, 123, 840–844.
Egan, J. P. (1948). Articulation testing methods.
Laryngoscope, 58(9), 955–991.
Feeney, M., & Schairer, K. (2014). Acoustic stape-
dius reflex measurement. In J. Katz, M. Chasin, K.
English, L. Hood, & K. Tillery (Eds.), Handbook of
clinical audiology (7th ed., pp. 165–186). Lippincott Williams and Wilkins.
Ferreira, G. M., Harrison, B. J., & Fontenelle, L. F.
(2013). Hatred of sounds: Misophonic disorder or
just an underreported psychiatric symptom? Annals
of Clinical Psychiatry, 25(4), 271–274.
Gumus, N. M., Gumus, M., Unsal, S., Yuksel, M.,
& Gunduz, M. (2016). Examination of insert ear
interaural attenuation (IA) values in audiological
evaluations. Clinical and Investigative Medicine,
39(6), 27507.
Guthrie, L. A., & Mackersie, C. L. (2009). A compari-
son of presentation levels to maximize word recognition scores. Journal of the American Academy of
Audiology, 20(6), 381–390.
Hall, J. III, & Mueller, G. (1998). Audiologists’ Desk
Reference (Vol. 2). Singular Publishing Group.
Harada, C. N., Love, M. C. N., & Triebel, K. L.
(2013). Normal cognitive aging. Clinics in Geriatric
Medicine, 29(4), 737–752.
Hedden, T., & Gabrieli, J. D. (2004). Insights into the
ageing mind: A view from cognitive neuroscience.
Nature Reviews Neuroscience, 5(2), 87–96.
Hirsh, I. J., Davis, H., Silverman, S. R., Reynolds, E.
G., Eldert, E., & Benson, R. W. (1952). Development of materials for speech audiometry. Journal of
Speech and Hearing Disorders, 17, 321–337.
Hoffman, H. J., & Reed, G. W. (2004). Epidemiol-
ogy of tinnitus. Tinnitus: Theory and Management,
16, 41.
Hunter, L., & Sanford, C. (2014). Tympanometry and
wideband acoustic immittance. In J. Katz, M. Chasin, K. English, L. Hood, & K. Tillery (Eds.), Hand-
book of clinical audiology (7th ed., pp. 137–163).
Lippincott Williams and Wilkins.
Jerger J. (1970). Clinical experience with impedance
audiometry. Archives of Otolaryngology, 92(4), 311–
324. https://doi.org/10.1001/archotol.1970.0431
0040005002
Kahneman, D. (1973). Attention and effort. Prentice-
Hall.
Khalfa, S., Dubal, S., Veuillet, E., Perez–Diaz, F., Jou-
vent, R., & Collet, L. (2002). Psychometric normalization of a hyperacusis questionnaire. Journal
for Oto-Rhino-Laryngology and Its Related Specialties,
64(6), 435–442.
Killion, M. C., Niquette, P. A., Gudmundsen, G. I.,
Revit, L. J., & Banerjee, S. (2004). Development of
a quick speech-in-noise test for measuring signalto-noise ratio loss in normal-hearing and hearingimpaired listeners. Journal of the Acoustical Society of
America, 116, 2395–2405.
Klein, A. J., Armstrong, B. L., Greer, M. K., & Brown,
F. R., 3rd (1990). Hyperacusis and otitis media in
individuals with Williams syndrome. Journal of
Speech and Hearing Disorders, 55(2), 339–344.
https://
doi.org/10.1044/jshd.5502.339
Lawson, G. D., & Peterson, M. E. (2011). Speech audi-
ometry. Plural Publishing.
Lehiste, I., & Peterson, G. (1959). Linguistic con-
siderations in the study of speech intelligibility.
Journal of the Acoustical Society of America, 31,
280–286.
Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tra-
nel, D. (2012). Neuropsychological assessment (5th
ed.). Oxford University Press.
Lidén, G., Peterson, J. L., & Björkman, G. (1969).
Tympanometry. A method for analysis of middleear function. Acta Oto-Laryngologica. Supplemen-
tum, 263, 218–224.
Lin, F. R., Yaffe, K., Xia, J., Xue, Q. L., Harris, T. B.,
Purchase–Helzner, E., . . . Health ABC Study Group,
F. T. (2013). Hearing loss and cognitive decline in
older adults. JAMA Internal Medicine, 173(4),
293–299.
Mahoney, C. F. O., & Luxon, L. M. (1996). Misdi-
agnosis of hearing loss due to ear canal collapse:
Areport of two cases. Journal of Laryngology and
Otology, 110, 561–566.
Mathai, J. P., Aravinda, H. R., Appu, S., & Urs, H.
R. (2021). Prevalence and audiological findings of
functional hearing loss: A retrospective study. Jour-
nal of Indian Speech Language & Hearing Association,
35(2), 33–38.
Meikle, M. B., Stewart, B. J., Griest, S. E., & Henry,
J. A. (2008). Tinnitus outcomes assessment. Trends
in Amplification, 12(3), 223–235. https://doi.org/
10.1177/1084713808319943
Meyer, D. H., & Mishler, E. T. (1985). Rollover mea-
surements with Auditec NU-6 word lists. Journal of
Speech and Hearing Disorders, 50, 356–360.
CHAPTER 5 Adult Assessment and Differential Diagnosis
https://t.me/medicina_free
233
Meikle, M. B., Henry, J. A., Griest, S. E., Stewart, B.
J., Abrams, H. B., McArdle, R., . . . Vernon, J. A.
(2012). The tinnitus functional index: Development of a new clinical measure for chronic, intrusive
tinnitus. Ear and Hearing, 33(2), 153–176.
Michiels, S., Ganz Sanchez, T., Oron, Y., Gilles, A.,
Haider, H. F., Erlandsson, S., . . . Hall, D. A.
(2018). Diagnostic criteria for somatosensory tinnitus: A Delphi process and face-to-face meeting to establish consensus. Trends in Hearing, 22,
2331216518796403.
Moore, B. C., Huss, M., Vickers, D. A., Glasberg, B.
R., & Alcántara, J. I. (2000). A test for the diagnosis of dead regions in the cochlea. British Journal of
Audiology, 34(4), 205–224.
Murman, D. L. (2015, August). The impact of age
on cognition. Seminars in Hearing, 36(3), 111–
121.
Newman, C. W., Jacobson, G. P., & Spitzer, J. B.
(1996). Development of the Tinnitus Handicap
Inventory. Archives of Otolaryngology-Head & Neck
Surgery, 122(2), 143–148.
Perkins, C. J., & Mitchell, S. (2022). Audiology clinical
masking. StatPearls Publishing.
Pichora-Fuller, M. K., Kramer, S. E., Eckert, M. A.,
Edwards, B., Hornsby, B. W., Humes, L. E., . . .
Wingfield, A. (2016). Hearing impairment and
cognitive energy: The framework for understanding effortful listening (FUEL). Ear and Hearing, 37,
5S–27S.
Salthouse, T. (2012). Consequences of age-related
cognitive declines. Annual Review of Psychology, 63,
201.
Salthouse, T. A. (2009). When does age-related cog-
nitive decline begin? Neurobiology of Aging, 30(4),
507–514.
Salthouse, T. A., & Meinz, E. J. (1995). Aging, inhibi-
tion, working memory, and speed. The Journals of
Gerontology Series B: Psychological Sciences and Social
Sciences, 50(6), P297–P306.
Schlauch, R. S., & Nelson, P. (2015). Puretone evalua-
tion. In J. Katz, M. Chasin, K. English, L. J. Hood,
& K. L. Tillery (Eds.), Handbook of clinical audiol-
ogy (7th ed., pp. 29–47). Wolters Kluwer.
Schröder, A., Vulink, N., & Denys, D. (2013). Miso-
phonia: Diagnostic criteria for a new psychiatric
disorder. PLoS ONE, 8(1), e54706.
Silverman, S. R., & Hirsh, I. J. (1955). Problems
related to the use of speech in clinical audiometry.
Annals of Otology, Rhinology, and Laryngology, 64(4),
1234–1244. https://doi.org/10.1177/00034894 5
506400424
Silverman, J. J., Galanter, M., Jackson-Triche, M.,
Jacobs, D. G., Lomax, J. W., Riba, M. B., . . . Yager,
J. (2015). The American Psychiatric Association
practice guidelines for the psychiatric evaluation
of adults. American Journal of Psychiatry, 172(8),
798–802.
Sung, R. J., & Sung, G. S. (1976). Study of the clas-
sical and modified alternate binaural loudness balance tests in normal and pathological ears. Journal of
the American Audiology Society, 2(2), 49–53.
Surprenant, A. M., & DiDonato, R. (2014). Commu-
nity-dwelling older adults with hearing loss experience greater decline in cognitive function over time
than those with normal hearing. Evidence-Based
Nursing, 17(2), 60–61. https://doi.org/10.1136/
eb-2013-101375
Tillman, T. W., & Jerger, J. F. (1959). Some factors
affecting the spondee thresholds in normal-hearing
subjects. Journal of Speech and Hearing Research, 2(2),
141s146. https://doi.org/10.1044/jshr.0202.141
Tyler, R. S., Pienkowski, M., Roncancio, E. R., Jun,
H. J., Brozoski, T., Dauman, N., . . . Moore, B. C.
(2014). A review of hyperacusis and future directions: Part I. Definitions and manifestations. Ameri-
can Journal of Audiology, 23(4), 402–419.
Vernon, J. A. (1987). Pathophysiology of tinnitus:
Aspecial case––hyperacusis and a proposed treatment.
The American Journal of Otology, 8(3), 201–202.
Vitoratou, S., Hayes, C., Uglik–Marucha, E., & Greg-
ory, J. (2020). Selective sound sensitivity syndrome
scale (s–five): A psychometric tool for assessing
misophonia. Summary on three waves of sampling
and analysis. Prominent Papers in Psych, 1–29.
Wang, T. C., Chang, T. Y., Tyler, R., Lin, Y. J., Liang,
W. M., Shau, Y. W., . . . Tsai, M. H. (2020). Noise
induced hearing loss and tinnitus
— new research
developments and remaining gaps in disease assessment, treatment, and prevention. Brain Sciences,
10(10), 732.
Willems, M., Acke, F., Lannon, B., Leyssens, L.,
Maes, L., & Marks, L. (2022). Global data on ear
and hearing screening in an intellectual disability
population. American Journal on Intellectual and
Developmental Disabilities, 127(2), 125–134. https://
doi.org/10.1352/1944–7558–127.2.125
Wilson, P. H., Henry, J., Bowen, M., & Haralambous,
G. (1991). Tinnitus Reaction Questionnaire: Psychometric properties of a measure of distress associ-
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
234
ated with tinnitus. Journal of Speech, Language, and
Hearing Research, 34(1), 197–201.
Wilson, R. H., & Burks, C. A. (2005). The use of 35
words to evaluate hearing loss in terms of signalto-babble ratio: A clinical protocol. Journal of
Rehabilitation Research and Development, 42, 839–
852.
Wilson, R. H., McArdle, R. A., & Smith, S. L. (2007).
An evaluation of the BKB-SIN, HINT, QuickSIN, and WIN materials on listeners with normal
hearing and listeners with hearing loss. Journal of
Speech, Language, and Hearing Research, 50, 844–
856.
Wu, M. S., Lewin, A. B., Murphy, T. K., & Storch,
E. A. (2014). Misophonia: Incidence, phenomenology, and clinical correlates in an undergraduate student sample. Journal of Clinical Psychology, 70(10),
994–1007.
Yacullo, W. S. (2015). Clinical masking. In J. Katz,
M. Chasin, K. English, L. J. Hood, & K. L. Tillery
(Eds.), Handbook of clinical audiology (7th ed., pp.
77–111). Wolters Kluwer.
CHAPTER 5 Adult Assessment and Differential Diagnosis
https://t.me/medicina_free
235
Practice Questions
1. A 37-year-old female is on your schedule for a comprehensive audiological evaluation. Which
assessments should be completed as part of this evaluation?
a. Pure-tone air and bone conduction, SRT, and word recognition
Pure-tone air conduction, SRT, and word recognition
b.
c.
Pure-tone air and bone conduction, SRT, and acoustic immittance
Pure-tone air conduction, SRT, word recognition, and acoustic immittance
d.
Explanation: To be considered a full comprehensive audiologic evaluation, all four assessments of
pure-tone air- and bone-conduction audiometry along with SRT and word recognition must be completed. When all four are completed in one session, this is defined as a comprehensive audiologic
evaluation and billed using the CPT code 92557. Acoustic immittance is billed under separate codes
and is not necessary for a comprehensive evaluation. Therefore, answer a is the correct answer.
2. The speech recognition threshold (SRT) can be best defined as:
a. The lowest level an individual can understand at least one NU-6 word
b. The lowest level that an individual can understand at least 50% of spondee words
c. The lowest level that an individual can understand at least 75% of spondee words
d. The lowest level that an individual can understand at least 50% of NU-6 words
Explanation: The SRT is defined as the level that a patient can understand a closed set of words
50% of the time. Familiarization and verification of the words to the patient is an important step in
SRT testing as it has been shown to influence the threshold by as much as 5 dB. This is important
because one of the most common clinical uses of SRT is cross-check validation of pure-tone thresholds.
Therefore, answer b is the correct answer.
3. Your next patient of the afternoon is a 58-year-old male who was referred to you with the
complaint of right constant acute tinnitus. Based on your knowledge of tinnitus, the time frame
for acute tinnitus would mean that the patient has been suffering from tinnitus for:
a. Three months or less
b. Six months or less
c. Six months or more
d. A year or less
Explanation: When describing the duration of tinnitus, the terms chronic and acute are used. When
an individual is experiencing acute tinnitus, that means they have experienced these symptoms for 6
months or less. With that in mind, answer b is the correct answer.
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
236
4. Mr. Friedman, a right-handed 24-year-old male with complaints of difficulty listening in
background noise and on the phone, is seen for an audiological evaluation. Otoscopy was clear
bilaterally, and the next test was immittance. Type A tympanograms were recorded bilaterally.
On reflex testing, there are present responses in the left ipsilateral and contralateral conditions,
but absent responses in the right ipsilateral and contralateral conditions. Without further
testing, where would the suspected lesion be?
a. CN VIII right
b.
CN VIII left
CN VII right
c.
d.
CN VII left
Explanation: First, we must remember that ANSI standards for MEMRs are based on the stimulus
ear. Present left ipsilateral responses suggest that the middle ear, cochlea, cranial nerve (CN) VIII,
ventral cochlear nucleus (VCN), superior olivary complex (SOC), facial nerve nuclei (FNN), and the
facial nerve (CN VII) are functioning properly on that side. Absent right ipsilateral responses suggest
that there is an issue in one of those structures on the right side. Present left contralateral responses
suggest that the left cochlea, left CN VIII, left VCN, right and left SOC, right FNN, and right CN
VII are functioning. Absent right contralateral responses suggests that the issues are either in the right
CN VIII or VCN, so a is the correct answer.
5. A 42-year-old male presents to your office with complaints of right hearing loss and tinnitus.
He stated that he is a factory worker and noted the issues suddenly after work one day when an
explosion occurred. Tympanometry revealed Type A tympanograms bilaterally. DPOAEs were
present and robust. MEMRs were present bilaterally. Audiometry revealed a unilateral moderate
to moderately severe sensorineural hearing loss in the right ear. You completed the Stenger test,
during which the patient did not respond. What would be your diagnosis?
a. Conductive hearing loss
b. Presbycusis
c. Retrocochlear hearing loss
d. Nonorganic hearing loss
Explanation: Although the patient presented with hearing loss and tinnitus in the right ear, the
objective tests (tympanometry, DPOAEs, and MEMRs) do not align with our subjective findings
(audiometry). Additionally, the patient did not respond during the Stenger test (positive Stenger). As
such, the patient would be diagnosed with nonorganic hearing loss and would be referred for further
testing such as an ABR, ENT, and/or psychology. Therefore, d is the answer.
6. Which of the following is true of otoacoustic emissions?
a. They are impacted by disorders of the auditory nerve.
b. They are by-products of OHC function and the cochlear amplifier.
c. They are not impacted by middle ear dysfunction.
d. The strength of the emission is the most important quality of the response.
CHAPTER 5 Adult Assessment and Differential Diagnosis
https://t.me/medicina_free
237
Explanation: The cochlear amplifier is created by OHC motility. As the traveling wave moves through
cochlear fluid creating displacement of the basilar membrane, there is a significant energy loss due to
viscous drag. Because of this energy loss, the cochlear amplifier is a necessary component of cochlear
function. The cochlear amplifier enhances the traveling wave as it loses energy. As a result of the
cochlear amplifier, there is displacement of the basilar membrane that creates energy movement back
toward the basal end of the cochlea generating vibration on the oval and round windows and thus
vibration of the ossicular chain and tympanic membrane. Therefore, answer b is the correct answer.
7. What is one of the main advantages of DPOAEs over TEOAEs?
DPOAEs offer better cochlear frequency resolution.
a.
b.
Middle ear status does not impact DPOAE responses.
DPOAEs can be observed with higher degrees of hearing loss.
c.
d.
DPOAEs are a better predictor of behavioral hearing thresholds.
Explanation:
Due to the continuous tone presentation used with DPOAEs, they tend to be impacted
less by subtle ear conditions compared to TEOAEs. Therefore, DPOAEs can be recorded in individuals
with up to moderate hearing losses, whereas TEOAEs are typically absent in individuals with more
than a mild hearing loss (20–30 dB HL). Therefore, answer c is the correct answer.
8. You completed a neurodiagnostic ABR on a 49-year-old male patient. You noted that wave __
was absent. As such, you completed an ECochG to attempt to see this wave, which is generated
where?
a. I; distal end of the VIIIth nerve
b. I; proximal end of the VIIIth nerve
III; distal end of the VIIIth nerve
c.
d. III; caudal brainstem; near superior olivary complex (SOC) and trapezoid body
Explanation: An ECochG is a variation of an ABR, which increases the amplitude of wave I due to
different click rates, intensity levels, and transducers. When wave I is not present, an ECochG can be
utilized. Wave I (also referred to as AP) is generated at the distal end of the VIIIth nerve, which would
make a the correct answer.
9. A 36-year-old male presents with an onset right hearing loss and tinnitus in the last 2 days. He
denied any hearing loss, tinnitus, and other audiologic symptoms prior to this occurrence. He
denied recent noise exposure, otalgia, aural fullness, and dizziness. Audiological testing revealed
normal hearing in the left ear and a moderate flat SNHL in the left ear. Tympanometry was
normal. Ipsilateral MEMRs were present in the left ear and absent in the right. Clinically, this is
most consistent with which pathology?
a. Otosclerosis
b. Sudden SNHL (SSNHL)
c. Otitis media with effusion
d. Ménière’s disease
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
238
Explanation: Based on patient complaints, timeline (of 2 days), and audiological findings, the most
consistent pathology is SSNHL. Therefore, b is the correct answer. It is imperative for audiologists to
refer these patients to ENT for treatment as soon as possible. Treatment should be initiated as soon as
possible after the onset of the hearing loss and generally consists of systemic (oral pill) or intratympanic
injection of corticosteroids in order to reduce inflammation or swelling. Treatment is difficult because
only about 10% of patients with SSNHL have an identifiable etiology. When treatment is delayed by
2 weeks or more, it becomes less likely that permanent hearing loss will improve.
10.
A 48-year-old female presented in the clinic with the following findings: normal hearing
sensitivity in the right ear and a mild sloping to moderate SNHL in the left ear. Word
recognition scores were 92% in the right ear and 24% in the left ear. High-intensity ABR testing
revealed normal findings in the right ear and prolonged wave V latency in the left ear with a
prolonged wave I to V interpeak latency. These findings would be most consistent with which
pathology?
a. Ménière’s disease
b. Otosclerosis
c. Otitis media
d. Acoustic neuroma
Explanation: The patient is presenting with left SNHL, poorer than expected word recognition scores,
and prolonged absolute and interpeak latencies on an ABR. Additionally, findings are asymmetrical
for all testing completed. Therefore, these findings point to a suspected acoustic neuroma, which is
answer d.
CHAPTER 5 Adult Assessment and Differential Diagnosis
https://t.me/medicina_free
Appendix 5–A
Objective Assessment, Clinical Utility, and
Anatomical Sites of Testing
OBJECTIVE ASSESSMENT CLINICAL UTILITY ANATOMICAL SITE
239
Tympanometry Tympanic membrane mobility
Ossicular/middle ear pathologies
Wideband Tympanometry Tympanic membrane mobility
Middle ear pathologies
Middle Ear Muscle Reflex Diagnosis of a retrocochlear versus
cochlear site of lesion
Used as a cross-check principle for
cochlear implant testing
Acoustic Reflex Decay Diagnosis of a retrocochlear versus
cochlear site of lesion
Otoacoustic Emissions Reflect the frequency resolution of the
cochlea
Can be a predictor of hearing loss
Newborn hearing screenings
Aid in differential diagnosis between
cochlear and retrocochlear pathology
Auditory Brainstem Response
(Waves I–V)
Threshold estimation
Site-of-lesion testing and physiological
integrity of auditory pathways
Tympanic membrane
Middle ear
Tympanic membrane
Middle ear
Stapedial muscle
Low auditory brainstem pathway
Stapedial muscle
Low auditory brainstem pathway
Outer hair cells and cochlear
amplifier
Highly influenced by outer and
middle ear systems
Wave I: Distal end of CN VIII
Wave II: Proximal end of CN
VIII
Middle Latency Response
(Na-Pa-Nb-Pb)
Threshold estimation site-of-lesion
testing and physiological integrity of
auditory pathways
Wave III: Caudal brainstem;
near cochlear nucleus
Wave IV:
complex (SOC)
Wave V: Lateral lemniscus (LL)
with contributions of the inferior
colliculus (IC)
Trough after V: IC
Thalamocortical pathways
(thalamus through primary
auditory cortex)
Superior olivary
continues
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
240
APPENDIX 5–A. continued
OBJECTIVE ASSESSMENT CLINICAL UTILITY ANATOMICAL SITE
Late Latency Response
(P1-N1-P2)
Threshold estimation
Physiological integrity at the level of
the primary auditory cortex
Monitoring neural plasticity and
maturation of auditory pathways,
especially after cochlear implantation
Amplification verification through
aided responses
MMN Reflects the cerebral response of
auditory memory, discrimination, and
processing abilities
P300 Reflects processing speed and neural
effort on various auditory processing
tasks
P1: Primary auditory cortex
(hippocampus, planum
temporale, lateral temporal
cortex)
Primary auditory cortex
N1:
and superior temporal gyrus
(Heschl’s gyrus)
P2: Primary and secondary
auditory cortices
Auditory cortex, frontal cortex,
hippocampus, thalamus
Primary auditory cortex, frontal
cortex, hippocampus
Cerumen
https://t.me/medicina_free
ELECTRO-
SPEECH
PURE-TONE
TABR & NABR:
PHYSIOLOGY INTERVENTION
SRT-PTA
AUDIOMETRY
CHL or mixed
AUDIOMETRY
removal
ENT referral
reduced
absolute latencies
prolonged; normal
interpeak latencies;
reduced amplitude
ECOG:
match
Good to
excellent WRS
HL
SP/AP
All normal ENT referral
match
Good to
excellent WRS
ENT referral
Retest after
medical
management
TABR & NABR:
absolute latencies
prolonged; normal
interpeak latencies;
reduced amplitudes
SRT-PTA
match
Good to
excellent WRS
CHL or
mixed; max
conductive
component of
60 dB HL
continues
reduced to absent
SP/AP
ECOG: WNT;
COMPLAINTS/
HISTORY OTOSCOPY IMMITTANCE OAES
Reduced
to absent
Tymp: Type B
tympanogram
with small ECV
Occluding
Cerumen
Decreased
hearing; aural
fullness; otalgia
MEMR: WNT
WNT
Decay:
All normal Present Normal SRT-PTA
Bony
growths in
complaints
EC
Reduced
to absent
Type
Tymp:
As or B
tympanogram
with normal
Red EC;
debris in EC
Drainage;
aural fullness;
otalgia; foul
smell; decreased
ECV
MEMR: WNT
hearing
Decay: WNT
Appendix 5–B
PATHOLOGY
Cerumen
Differential Diagnosis
Impaction
Exostoses No major
Otitis
Externa (OE)
Соседние файлы в папке Библиотека им академика М.И. Перельмана